Provider Demographics
NPI:1922756642
Name:KOKUA SUPPORT SERVICES
Entity Type:Organization
Organization Name:KOKUA SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CSAC, CSAPA
Authorized Official - Phone:808-847-4227
Mailing Address - Street 1:PO BOX 29819
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2219
Mailing Address - Country:US
Mailing Address - Phone:808-847-4227
Mailing Address - Fax:808-842-0044
Practice Address - Street 1:1130 N NIMITZ HWY RM A226
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5781
Practice Address - Country:US
Practice Address - Phone:808-847-4227
Practice Address - Fax:808-842-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty